Why Acne Scars Occur
What is a scar exactly?
A scar is defined as the fibrous tissue that replaces normal tissue destroyed by injury or disease. In the normal healing process, cells undertake a repair process that includes breakdown of old tissue and production of new tissue. In most cases, this healing process results in a near perfect replication of the damaged tissue. Scars develop as a result of the body’s attempt to repair the surrounding tissue that has been wounded or injured where the healing process was unable to completely replace the lost or damaged tissue. Additionally, scar tissue — collagen — often forms a harder, more pronounced surface than regular healthy tissue. So basically, acne scarring is the result of damage in excess of what the body can normally heal, resulting in depressed or raised, hard, thickened areas of skin.
When a scar forms as a result of acne, it’s due to inflammation associated with the acne itself. As the inflammation extends deeper into the skin’s surface, more tissue damage occurs and the chance for scarring is greater.
The process of developing a scar can be broken down into 4 stages:
Most people believe that acne is caused by several inciting events and it’s not always clear which event occurs first. However, it is well known that some combination of a) hyperkeratinization which is an overgrowth of epithelial cells that line the pores, b) increased production of sebum (sticky, oily substance made in the pores), c) growth of specific bacteria called P.acnes, and d) inflammation can start the acne cascade.1
All of the factors contributing to the acne in Stage 1 trigger a release of proteins and enzymes that damage the local tissue.2
The inflamed lesion opens and spills out into the surrounding tissue, releasing even more inflammatory chemicals.3
The tissue starts to heal as new capillaries form, growth factors are released, new collagen is laid down, and some of it is “dissolved” by natural enzymes — so that eventually the skin appears normal. When this repair process cannot keep up with the degree of damage, it can develop into a scar.4